Why I Adopted The “Hell Yes” Policy

It seems like natural human tendency to explain ourselves. When we are late to a meeting, we come up with an excuse in case anyone asks. When our kid starts throwing a temper tantrum at the store, people stare at us expecting an apology. In the same way, when we decide that there are things outside of medicine that are more important to us than the job – an explanation seems required. That’s until you adopt a “Hell Yes” policy.

I am here to say I am done playing this game.

And, as you’ll see, I don’t think you should keep playing either.

Losing Our Self-Identity

I’ve been on several podcasts recently. One of the themes that keeps presenting itself is how we define our self-identity when we earn a paycheck as physicians.

How do you define who you are? If you aren’t sure, a great way to figure this out is to see what you say when someone asks you to “tell me a little bit about yourself. Who are you?”

Self Identity in Medicine

For those that don’t feel like clicking the link, here is my typical answer when I am asked to “tell me a little bit about yourself”.

“Well, I am a God-fearing husband and father of three. I am an author, inventor, teacher, blogger, and golf-playing craft beer lover. I also happen to be a physician who practices anesthesia.”

This might seem trite, but answering questions about my identity in this way serves two purposes.

First, I am speaking truth into my own life. It is a reminder of who I am and why I am here on this earth. As life gets busy, sometimes we forget what’s truly important. I am a physician, but that is not what defines me. Reminding myself of that is important.

Second, it is imperative to me that my readers, which include medical students and residents, see that you can be good at your job as a physician and have other priorities in this life. Being a physician does not have to be an all-consuming act despite what other generations would have you believe.

Competing Priorities Leads to Burnout

Unfortunately, our priorities that define our identity can often be at odds with each other. We can’t always be the greatest doctor, spouse, and parent.

When my wife started full-time in July – for the first time – I was forced to choose between my priorities. My job as a dad tripled while my work requirements at the hospital remained at 1.3 FTE (130% of a full-time schedule). This doesn’t even include my research and education efforts.

All of a sudden, there simply weren’t enough hours in the days or weeks to accomplish everything that I had planned. Apparently, having a voracious appetite for setting and achieving goals has its limits.

With a realization that my time was limited, I couldn’t waste another second on things that didn’t matter to me. It really brought everything into perspective.

Honestly, it also completely burned me out. Given that I’ve been writing about physician burnout for a year, the irony was not lost on me, but it was happening whether I wanted it to or not.

This led my wife and I to have a lot of conversations about what mattered most to us, which can be easily accomplished using the Three Kinder Questions.

If we were suddenly living the ideal life, what would that look like? If we knew our days on this earth were numbered, what would that change?

There were a lot of common threads throughout these talks. For example, we wanted to be at all of our kids’ extracurricular and school events. We also wanted to travel, spend time with family and friends, and pursue our passions.

As these talks progressed, I started to notice that none of my goals involved increasing my number of publications to get more notoriety, staying later at work, or whether I’ll ever make full professor in academics.

Does that make me a bad doctor or academician? No. I still hold to some of these goals, but they are just lower on the priority list than they used to be. And, that’s okay.

The Generational Gap

When I started saying “no” to new committee opportunities and commitments, I often felt like people were staring at me. The squeaky wheel might get the grease, but it also seems to get a lot of attention from a certain crowd.

You know what I am talking about. The people who say things like “being a doctor is a noble calling that requires sacrifice!” Or maybe you’ve heard people say something like “suck it up, you’re a doctor.” This is the same group that says doctors shouldn’t retire early.

The expectation here is that being a physician is who we are, and that it is an all-consuming calling that requires everything else to be sacrificed at the altar of being a dedicated (i.e. non-complaining) physician.

These conversations remind me that there continues to be a generational gap between those who identify with a Generation X mentality and the millennial physicians who are coming into the fold.

The Generation X thought process demands that we put our hands to the plow, put our head down, and push until someone tells us to stop or the job is done. If we do stop before the job is done, and our hands aren’t bloody, we are clearly not dedicated to the cause.

The millennial mindset asks why the plow is shaped the way that it is, if we can get the job done more efficiently using a different method, and if we can make the process better for everyone involved.

These questions lead to a uniform response: Don’t you dare ask questions, young millennial! You haven’t had enough trips around the sun. There is a reason we are the way that we are!

Take Home: The “Hell Yes” Policy

My point is this. Many doctors (young and old) are tired of having to choose between work and life. If they can’t have both work and life, many of them are choosing the latter.

It is not my job to explain to others that being a husband and father matters more to me than my job. It is also not my job to care what others think about that.

I simply don’t have enough time in my life to accomplish everything. This has resulted in a “Hell yes” policy where I only say yes to things that I can’t refuse.

Otherwise, I risk burning out completely or missing out on the people and things that matter most to me in this life.

We should all refuse to lose our identity in our jobs. And when others call us on it, remember that it is not our responsibility to explain ourselves. It’s okay to care more about things outside of medicine.

And, if something doesn’t make you say, “Hell Yes!” then you should probably just say, “no.”

Have you ever had to choose between work and life? How did your colleagues handle that? What advice would you give to others who are struggling with this balance? Leave a comment.

Great post, TPP. This mindset goes way beyond physicians. Too many of us find our identities in our work. If that’s the case, other areas of our lives will suffer, as you rightly point out.

If you enjoy and find value in your work, whatever it may be, by all means, stay as long as that exists. When it becomes your identity, it’s time to reevaluate. Your post is a good reminder to all of us, not just physicians.

Right on. There is no need to explain your life choices to anyone except to yourself and your family. No justification needed. You have to prioritize what’s important in your life and then build work around it. I’m Gen X and I do see some of the attitude you describe. I’m happy to see more conversation in the physician community revolve around FI, work-life balance, and burnout. A happy physician is a better physician. Best of luck on your journey brother.

Whenever I have to facet the decision between work and life. I ALWAYS choose life. Unapologetically and without exception.

Some people actually do live to work. That’s just not me. I’m definitely in the “work to live” camp. Luckily, my current situation allows me to perform meaningful work that benefits my livelihood. If it didn’t, then I wouldn’t do it.

Like you, I only say hell yes to the things I’m passionate about. To everything else, I gracefully say no.

Wow great read! Replace the word “doctor” in the article with “engineer” and it sums up how I think almost exactly.

It’s crazy how wanting to prioritize family and life over long weeks seems to send a message that you are not dedicated to your career. Engineering is a really fun job (I’m sure medicine is too!), but there are other things in life that are important as well!

Your analysis of millennials vs. gen X is interesting too. When I first started in 2005 people used to talk about their long work weeks with bravado, as if it were something to be proud of. “I worked 70 last week.” “Yeah well I worked 80.” “I worked 90! That’s why I’m wearing a T-shirt, no time for laundry!”

Nowadays the younger crowd seems to get cranky if they need to go much past 40 hours per week. The older partners complain about it, but I think it’s great and healthy for the industry. I know a lot of talented engineers who unfortunately burned out and left the profession for something with a more sane schedule.

If the answer isn’t “hell yes” then it’s “no”! I heard this on the Tim Ferris podcast before and love it!

ER docs are a little cruder, so I prefer the “F No!” correlary. If someone asks me if I want to do something not worth my time I just say “F no!” and go back to living my life. You should try it sometime. It’s good for the soul.

I’ve been reading “Essentialism” by Greg McKeown recently. It’s a great read, and your post makes me think of his chapter on tradeoffs. A person can’t be the best at everything, he or she has to make a choice. Choosing for *anything* is automatically choosing Against something else. If one doesn’t acknowledge this, it’s a recipe for being overloaded, burned out, and puts one at risk of “making a millimeter of progress in a million directions.” (quote from the book)

You can choose what your priority is and inform others (enthusiastic yes or graceful no), or the others will tell you what they think it should be and decide for you. He spends a whole chapter on having an arsenal of ways to say no.

The book is written more towards a business/innovator perspective, but I found it easily adaptable to my life as a physician and mother. I think you and your readers would appreciate his perspective.

I couldn’t agree more on the “choosing something” is essentially choosing against something else. It is so applicable here. I guess, prior to July, I always had the bandwidth to say yes and then it became necessary to choose.

1.3 FTE is insane! A full time academic job exceeds 60 hours a week by the time you add direct care, teaching, committee, research and grant writing. And there are publication expectations so you end up planning years at a time for projects. A single FTE in academia can demand all you have. 1.3 FTE is guaranteed burnout in academia alone even with the dedication of a monk like person with no other family life or obligations at all. No wonder you burned out. That is a completely unreasonable ask.

Yeah, it’s a combination of being short staffed and my wife starting full time. I was happy to work more and destroy some student loans for the first year. When my wife started back full-time, it just wasn’t sustainable anymore.

Her career satisfaction is really important to both of us. I want to support her dreams however I can, but that meant I needed (and still need) to say no to many things.

“you can be good at your job as a physician and have other priorities in this life”

Loved this, TPP.

Joan Didion once wrote of how saying no to anything she didn’t want to do but had felt social obligations or peer pressure to do previously freed her to have some of her most productive years of writing.

Here’s to a year of balance ahead. I’m looking forward to great things from you, my friend.

Now in my sixth month of retirement, a prototypical baby boomer who had to convince a skeptial admissions committee that I would be their most dedicated healer if given the chance. And in the ensuing 40 years, it is unlikely anyone would judge me lazy or neglecting a patient. Just like they expected, and also like I expected. But in a social setting when people asked what I did for a living, they learned that I sign things. There is always a shield to ensure that my wife and kids didn’t have to aspire to becoming patients to acquire Dad’s attention. Like it or not, though, the identity of becoming a worthy physician has its indelible imprint, which is probably why there is such a professional backlash to professional threats, be they the malpractice crisis of my student days or subservience to EHR and pre-auth now. No matter how effectively one functions as a physician, it can never be peak with whatever the barriers of the era impede it. Were the identity as a physician subordinate to other things, those threats would not elicit such a harsh reaction, as physicians retreat to other parts of their lives that allow them more inner peace.

For the most part, the physicians that I have known, many truly at the upper tier of my specialty, don’t skip their vacations, attend their children’s school events, still have their first wife when they retire, donate time and treasure to their communities, and have funerals with eulogies that speak of their art collections as much as their cv achievements. I think the challenge is less one of pursuing non-clinical ventures as it is to avoid being the involuntary slave to what can be a very alluring career.